Medial plantar venous flap technique for volar oblique amputation with no defects in the nail matrix and nail bed

Toshiya Yokoyama, Yasuyoshi Tosa, Masatoshi Hashikawa, Satoshi Kadota, Yoshiaki Hosaka
Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2010, 63 (11): 1870-4

BACKGROUND: Skin grafting is a simple technique used during volar oblique amputation; however, it is not appropriate to use this technique if the bone or tendon is exposed. Moreover, in volar oblique amputation, if the severed section is large and elongated, skin grafting makes the lack of volume conspicuous, and reconstruction with a V-Y advancement flap occasionally results in a nail deformity that resembles a parrot's beak. We used a medial plantar venous flap for the correction of large volar oblique amputation.

METHODS: Reconstructive surgery was performed on patients with volar oblique amputation in whom the proximal severed volar regions extended from the nail matrix to the distal interphalangeal (DIP) joint. The medial plantar venous flap was harvested, the distal subcutaneous vein or communicating vein of the medial plantar area was anastomosed to the proper digital artery, and the proximal vein of the flap was anastomosed to the dorsal subcutaneous vein of the stump of the digit.

RESULTS: The flaps survived in all the patients. At 12 months after the surgery, all the treated fingers had attained a good shape. Patients who underwent reconstruction with medial plantar venous flaps attained good sensory restoration.

CONCLUSION: In volar oblique amputation, if the remaining nail matrix and nail bed are uninjured, then patients can expect the restoration of shape, function and sensory input after surgery. In this study, we used the medial plantar venous flap for large volar oblique amputation cases and obtained good results.

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